The costs of hot drink scalds

August 2012

Each week, more than 300 children in the UK are rushed to hospital with hot drink scalds.1 Most of these children are very young and some will be left scarred for life. This article gives an overview of the financial and emotional costs of hot drink scalds among children. As NHS treatment costs vary widely, all of the costs shown should be treated as a guide.

The scale of the problem

Hot drink scalds are one of the most common childhood injuries and the leading cause of children being admitted to burns services. Every day in the UK, 45 children are taken to A&E departments with scalds from hot drinks - that's around 16,500 a year.1 In 2010-11 almost 1,200 children under the age of 15 were admitted to hospital in England and Wales with hot drink scalds.2

Almost nine in ten serious scalds from hot drinks involve under fives. In fact, hot drinks are the number one cause of scald injuries among young children.1 Hot drink scalds peak at the age of one or two, with most of these accidents happening when babies and toddlers pull a mug of tea or coffee onto themselves.

Children from the most deprived one-fifth of wards are three times as likely to be admitted to hospital with burns and scalds as those from the most affluent fifth.3

Table 1: Key costs for treating hot drink scalds in children and young people

Item

Cost

Ambulance transfer to hospital per person4

£255

A&E treatment per person4

£108-141

Annual cost of 16,500 A&E attendances

Around £1.8 million

Cost of a bed day in a specialist burns facility, to treat a minor burn or scald5

£750

Average cost of inpatient treatment for an uncomplicated minor scald (covering less than 10% of the body) from a hot drink6

£1,850

Annual cost of inpatient treatment for 1,200 admissions2

Around £2.2 million

Cost to the economy of a parent taking 3 days off work while their child is in hospital7

£2,280

The financial costs

Emergency care

Many children who have suffered a hot drink scald will be taken to hospital in an ambulance, at a cost of £2554. Each day in the UK, 45 children attend A&E following scalds from hot drinks - that's around 16,500 attendances a year.1 A&E treatment leading to admissions costs £141 or £1084 if the child is discharged to be looked after at home, putting the annual cost of these admissions at around £1.8 million.

Acute inpatient treatment

During 2010-11 in England and Wales, a total of 1,186 under 15s were admitted to hospital with hot drink scalds.2 Most hot drink scalds are minor, covering less than 10% of the body. They tend to affect the face, neck and top of chest. Children with these injuries are usually admitted to specialist burns services, which can involve long transfers by ambulance or helicopter. Most children will stay in hospital for 1-2 days, with each bed day costing around £750.5 Inpatient treatment can include the cleaning of wounds and application of biological dressings under general anaesthetic.

The cost of treating an uncomplicated minor scald from a hot drink has been calculated at £1,850.6 This puts the annual cost of admissions among 0-14 year olds at around £2.2 million.

However, the report authors note that £1,850 represents the lower end of treatment costs and that individual cases could cost significantly more. Factors that would increase the total cost of treatment include complications such as Toxic Shock Syndrome, wound infections, or the need for skin graft procedures. The life-threatening illness Toxic Shock Syndrome is rare but can occur following even small scalds, and requires treatment in intensive care.

Table 2: Example inpatient treatment costs for a 13 month old with a 4% partial thickness scald to right arm and abdomen caused by spillage of tea6

Item

Cost

Hospital bed in a specialist burns unit

£1,536

Theatre visits

£568

Dressings and medication

£65

Total

£2,169

Watch our video interview with Dr Amber Young, Consultant Paediatric Anaesthetist at Frenchay Hospital in Bristol, who talks about the financial and emotional costs of burns in children.

Long-term treatment

Children who have suffered a hot drink scald often need follow-up treatment after being discharged from hospital. This can include dressings and post-discharge clinic visits, pressure garments and scar review consultations. In most cases, the child will make a good recovery, with the damaged skin returning to normal over time. However, 1-5% of hot drink scalds require skin grafts which result in a need for lifelong scar management.1 Children with significant scarring may need psychological support to come to terms with their changed appearance.

Other costs

For a parent who is employed full-time, taking three days off work while their child is in hospital costs the economy £2,280.7 Time off work in these situations is often taken as unpaid leave, which can mean significant loss of earnings for the family. Parents could also have to pay the costs of travelling to a regional burns centre hundreds of miles from home.

The emotional costs

The effect on the child

Hot drink scalds can be extremely painful. Hospitals do all they can to make treatment as pain-free as possible, but the experience can still be traumatic. The majority of children admitted to hospital with a hot drink scald will recover well, with their skin returning to normal, but some will be left with lifelong scarring. They may have to use moisturising creams daily and wear pressure garments for up to two years. In cases where a skin graft is needed, the child may require frequent hospital admissions for further treatment.

Severe scarring from hot drink scalds can trigger social and psychological problems, and it's often these 'invisible scars' that need the most attention. The child may have difficulties coming to terms with their changed appearance and other people's reactions. They may develop social anxieties, particularly around occasions where they have to expose their scars, for example during swimming or sports events. All of these factors can reduce confidence and affect schoolwork, friendships and relationships.

The Hot Drinks Harm video, produced by North Bristol NHS Trust, shows how easily a young child can suffer a serious scald injury from a hot drink. Please note that some people may find the ending of the video shocking, as it depicts scarring caused by a hot drink scald.

The effect on families

Serious scalds can create a lifetime of guilt for parents or other family members who feel responsible for the accident. If a young child is left with permanent scars, parents and siblings will have to help the child understand why they look different to other children and come to terms with their injuries as they get older.

If the child is treated at a regional burns centre, parents could have to spend time away from home and any other children they have. They will then have to commit time to outpatient appointments and managing their child's injuries at home. These demands can be very disruptive to family life and have a particular effect on siblings.

The parent's perspective: Valerie's story

Valerie Jackson's life was turned upside-down when her 10-month old son, Gabriel, spilled a cup of tea on himself. Gabriel was crawling around, happily exploring the living room, when he grabbed the cup of tea and tipped it over himself.

Valerie's husband Peter reacted quickly and took Gabriel to the bathroom to rinse him in cold water. Gabriel's skin was peeling away where the hot liquid had touched him, so his parents rushed him to hospital. Gabriel had his wounds cleaned and as he was in a lot of pain, he was given morphine. The doctors found that the burns covered 10% of Gabriel's body, so he was transferred to a specialist burns unit.

"Everyone in the burns unit was there because of an accident," said Valerie. "None of them were born that way and they hadn't developed a disease to make them disfigured. In a split second their whole life changed."

Gabriel spent two days in hospital and had to wear bandages for a long time afterwards. Three years later, Valerie says she's delighted at how quickly her son recovered. The skin on Gabriel's back and chest has been left discoloured and he has thick, permanent scarring under his arm, but his face, the most vulnerable area, was spared from the burns.

How could it be prevented?

Babies and young children are particularly vulnerable to scalds from hot drinks because their skin is much thinner than an adult's. Most people are not aware that a mug of hot drink with milk, left standing for 10 minutes, can scald a baby or toddler in less than 1.5 seconds.

Table 3: Common types of hot drink scald accident among under fives8

How the accident happened

% of cases

Child reached/pulled cup or mug of hot drink down

59%

Child poured/spilt hot drink

19%

Adult knocked and/or spilt hot drink over child

8%

Older children are more likely to suffer scalds from knocking a hot drink off a shelf (50% of these accidents among 5-10 year olds) or spilling the drink on themselves (75% of these accidents among 11-17 year olds).8

Community education campaigns can help to raise awareness of how to keep children safe from hot drink scalds. You can use home visits, group discussion sessions, DVDs, posters, leaflets and other activities to engage parents with the topic of hot drinks safety and encourage them to make simple changes to their behaviour that will reduce the risk of scalds. You can support changes in behaviour in the home and in early years settings.

CAPT resources

Our DVD resource pack Too hot to handle focuses on hot drink scalds as well as two other serious scenarios: bath water scalds and contact burns from oven hobs. The pack provides a ready-made safety session in a box, with:

support cards for practitioners – including key safety messages for preventing hot drink scalds, first aid advice, and ideas for group discussions and practical activities to drive home safety messages on hot drink scalds in an engaging way

flyers for parents and carers.

Our Keep hot drinks out of my reach leaflet reinforces safety messages around hot drink scalds – it’s an ideal resource to distribute to parents or carers as part of a community education project.

Our Hot drinks can hurt me poster provides an attractive visual reminder of the dangers posed by hot drinks and the need to keep them out of reach of babies and young children.

Hot drink scalds in your area

Are hot drink scalds one of the priority issues in your area? Are you running any programmes that aim to reduce the number of children suffering these injuries? Email us at info@makingthelink.net and we can publish the information on this website.